Student Application for the Friendship Family Program

* Full Name

Preferred Name

* Home Address

* City

* State

* Postal Code

Home Phone (xxx-xxx-xxxx)

Cell Phone (xxx-xxx-xxxx)

Email Address

Date of Birth

Gender

Female

Male

Transgender

Prefer not to disclose

* Religious Affliation

If you are new to Transylvania, what is your admissions status?

First Year Student

Transfer Student

Exchange Student for One Term

Exchange Student for One Year

If not already on campus, what is your expected date of arrival?

* Are you an international student?

Yes

No

If you are an international student, what is your country of citizenship?

If you are an international student, have you been to the US before?

Yes

No

* Please describe your academic interests

* Why are you interested in the friendship family program?

Preferred Marital Status of Host Family

Preferred Number of Residents in the home of your Friendship Family

Are you willing to be paired with a family that has young children?

* What do you do for fun? What are your hobbies?

* Intended Major

In what activities do you plan to participate in college?

Performing Arts

Instrumental Music

Vocal Music

Drama

Varsity Athletics

Other Activities

* Please list any food restrictions and any allergies

* Do you smoke?

Yes

No

* Do you speak a second language? If so, please specify.

* Would you like to have another student (perhaps a friend) matched with the same friendship family?

Yes

No

No preference

*

If you have a particular friendship family in mind, what is that family's name?

* If available, would you like to stay in Lexington during Thanksgiving week, Winter Break, and/or Spring Break, when residence halls are closed?

Yes

No

* If you have a problem with family pets, please describe

* Do you have any other special needs or concerns regarding friendship family placement?

* What do you hope to get out of the friendship family program experience?

*

What provisions would you like from your friendship family?

Picked up from airport upon arrival in Lexington

Housing or storage space during the summer

Trips within Lexington and/or Kentucky

Dinner with friendship family

Dropped off at airport when returning home

* Indicates Response Required